THE Health Care Financing Administration (HCFA) introduced on January 1,1992, a fee schedule1 for physician payment under Medicare based on the resource-based relative value scale (RBRVS) of Hsiao et al.2 In 1988, the then—chief administrator of HCFA outlined in detail why RBRVS was inappropriate for reform of the Medicare payment system3 (a skepticism that is said to persist within HCFA today). Congress nevertheless mandated the use of the RBRVS by HCFA. I criticized the RBRVS4 for, among other things, the fact that the scale attempts to establish relative values among specialties based on the putative value of different types of work without considering that some specialties are known to work many more hours per week than others. Fairness in designing a payment system requires that hourly reimbursement rates be computed.
See also p 3313.
The Commentaries of Hsiao et al5 and Radecki et al6